Anterior nasal packing [advanced]

Introduction

• Wash hands, Introduce self, Patients name, Explain procedure fully and get consent
• Explain it will be uncomfortable and they may need to cough up blood pushed back down – give them a bowel

Gather equipment

Preparation

• Apply gloves and apron
• Spray anaesthetic into nostril

Nasal tampon insertion

• Ensure nasal tampon has a suture attached at one end (if not, place one)
• Put KY jelly all over nasal pack
• With your non-dominant hand, push up on the tip of their nose
• Then immediately insert the nasal tampon into nostril horizontally in the sagittal plane (see image)
• Advance horizontally along the floor of the nasal cavity in one motion until maximum depth
• The outer tip with suture attached should be next to the tip of the nose
• Slowly expel the a few mls of saline from the syringe into the nostril to swell up the nasal pack like a tampon
• Tape the string on their cheek

Inflatable pack insertion

• Remove pack from its sleeve
• Place in bowel of sterile water (not saline) for 30 seconds
• With your non-dominant hand, push up on the tip of their nose
• Then immediately insert the inflatable pack into nostril horizontally in the sagittal plane (see image)
• Advance horizontally along the floor of the nasal cavity in one motion until maximum depth
• The outer tip with suture attached should be next to the tip of the nose
• Attach 10ml syringe full of air and inflate until pilot cuff is firm but with some bounce (no set volume)
• Tape the tubing to their cheek

Further management

• Full history and ABCDE assessment
• Secure IV access and send bloods including FBC, G&S, clotting
• Refer to ENT team for nasal cauterisation